Depression in late-life: Shifting the paradigm from treatment to prevention

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 08/2006; 21(8):746-51. DOI: 10.1002/gps.1555
Source: PubMed


Late-life depression is very common and is associated with high rates of morbidity and mortality. While the field of geriatric psychiatry is focused on depression treatment, prevention is an enticing option. Prevention of late-life depression would decrease both emotional suffering and depression-associated morbidity and mortality and may decrease dependence on non-mental health professionals to detect depression and to initiate a treatment referral. This paper will review current thinking on prevention research with a particular focus on its application to late-life depression. To illustrate these issues, we discuss recent and ongoing clinical trials of interventions to prevent depression in two populations of older persons: those with age-related macular degeneration (AMD) and those with cerebrovascular disease.

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    • "There is growing recognition that interventions geared toward preventing depression vs. treating it after it has occurred are both more humane and potentially cost-effective. Whyte and Rovner (2006) emphasize the importance of focusing on the prevention of depression in older adults. They present a modified form of the Institute of Medicine (IOM) Preventive Intervention Research Loop (Mrazek & Haggerty, 1994) that includes clearly delineating which older adults are at greatest risk for depression, developing the content of a preventive intervention and demonstrating the efficacy of the intervention in a controlled trial. "
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    ABSTRACT: The prevention of depression in individuals who are at risk is important for affected individuals, their family members, and for society at large. This study presents the results of a randomized clinical trial aimed at the prevention of depression in nursing home residents. Residents were screened with the Geriatric Depression Scale (GDS) and a diagnostic interview. Those with elevated GDS scores who did not meet diagnostic criteria for depression were randomly assigned to a treatment or control (treatment as usual, TAU) condition. The treatment was an adaptation of the Coping with Stress program developed by Clarke et al. (1995; Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312-321), and focused on various components typical of cognitive-behavioral treatment (CBT) programs (e.g. increasing pleasant events, reducing negative cognitions). Both groups were assessed on measures of depression before treatment, after treatment, and at 3- and 6-month follow-up points. Compared with the TAU group, residents receiving the intervention showed considerable improvement over the 6-month follow-up on the GDS. Average scores on the GDS, for example, went from 14.0 to 9.4 in the CBT group over the course of treatment and follow-up, vs. scores from 13.4 to 12.3 for the TAU group over the same time. However, results on the Center for Epidemiological Studies Depression Scale at 3 months were nonsignificant. Overall, the results of this study suggest that a brief, group-based CBT program can have significant benefit in nursing home residents at risk for depression.
    Aging and Mental Health 04/2009; 13(2):288-99. DOI:10.1080/13607860802380672 · 1.75 Impact Factor
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    • "There are indications that the field of psychology is increasing its attention to the unique needs of older adults. For example, interventions have addressed the prevention of suicide and depression in older adults (Heisel & Duberstein, 2005; Whyte & Rovner, 2006). In addition, the American Psychological Association (APA) Public Interest Directorate has established an Office on Aging, which coordinates APA activities pertaining to aging and geropsychology. "
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    ABSTRACT: The Major Contribution aimed at strengthening a prevention focus in psychology, so as to more effectively and equitably promote the well-being of all members of psychology communities. The 3 reactions (L. A. Bond & A. Carmola Hauf, 2007 [this issue]; L. Reese, 2007 [this issue]; E. Rivera-Mosquera, E. T. Dowd, & M. Mitchell-Blanks 2007 [this issue]) give strong support for the best practice prevention guidelines, while providing new insights for their implementation in the field of psychology. In this rejoinder, the authors make an effort to build upon their colleagues' ideas, by addressing the topics of community-based collaboration, prevention across the life span, and implementation of the best practice guidelines. The authors urge further interdisciplinary collaboration by members of the American Psychological Association, and others interested in prevention, and invite genuine action to expand prevention efforts.
    The Counseling Psychologist 07/2007; 35(4):594-604. DOI:10.1177/0011000006297158 · 1.82 Impact Factor

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